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<html>
<head>
<meta charset="UTF-8">
		<title>投诉反馈</title>
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</head>
	<body>

		<div class="x-body">
			<table class="layui-table">
				<xblock>
					<button class="layui-btn layui-btn-danger">投诉反馈</button>
				</xblock>
				<form class="layui-form" action="" method="post">
					<tr>
						<td style="width: 110px;"><span class="x-red">*</span>客户姓名</td>
						<td style="width: 400px;"> <input type="text" id="L_email" name="email" required="" lay-verify="email" autocomplete="off" class="layui-input" value=""></td>
						<td style="width: 110px;"><span class="x-red">*</span>客户电话</td>
						<td style="width: 400px;"> <input type="text" id="L_email" name="email" required="" lay-verify="email" autocomplete="off" class="layui-input" value=""></td>
						<td style="width: 110px;"><span class="x-red">*</span>保险种类</td>
						<td style="width: 400px;"> <input type="text" id="L_email" name="email" required="" lay-verify="email" autocomplete="off" class="layui-input" value=""></td>
					</tr>
					<tr>
						<td style="width: 100px;">投诉部门</td>
						<td style="width: 400px;"> <input type="text" id="L_email" name="email" required="" lay-verify="email" autocomplete="off" class="layui-input" value=""></td>
						<td style="width: 100px;">被投诉人</td>
						<td style="width: 400px;"> <input type="text" id="L_email" name="email" required="" lay-verify="email" autocomplete="off" class="layui-input" value=""></td>
						<td style="width: 100px;"><span class="x-red">*</span>受理人</td>
						<td style="width: 400px;"> <input type="text" id="L_email" name="email" required="" lay-verify="email" autocomplete="off" class="layui-input" value=""></td>
					</tr>
					<tr>
						<td style="width: 100px;">受理日期</td>
						<td style="width: 400px;"> <input type="text" id="L_email" name="email" required="" lay-verify="email" autocomplete="off" class="layui-input" value=""></td>
						<td style="width: 100px;">反馈日期</td>
						<td style="width: 400px;"> <input type="text" id="L_email" name="email" required="" lay-verify="email" autocomplete="off" class="layui-input" value=""></td>
						</tr>
					<tr>
						<td>投诉内容</td>
						<td colspan="5"><textarea name="" rows="4" cols="160"></textarea></td>
					</tr>
					
				
					
					
					<tr>
						<td>备注</td>
						<td colspan="5"><textarea name="" rows="4" cols="160"></textarea></td>
					</tr>

					<tr>
						<td ><a _href="www.baidu.com">  <input class="layui-btn layui-btn-danger" type="submit" value="保存" /></a></td>

						</tr>
				</form>
			</table>
		</div>
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		<script>
			layui.use(['form', 'code'], function() {
				form = layui.form;

				layui.code();

				$('#x-city').xcity('湖北', '武汉市', '洪山区');

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